Dr. Oliver Sacks , a neurologist and lover of music, is convinced of the music’s unique capacity to connect a person with dementia to their preserved self. He says in his book Musicophilia , “It is the inner life of music which can still make contact with their inner lives, with them; which can awaken the hidden, seemingly extinguished soul; and evoke a wholly personal response of memory, associations, feelings, images, a return of thought and sensibility, an answering identity.” Whether it is because music is used as a trigger, or because it’s a non-verbal means of expression, it has the ability to re-connect neurological pathways that may be intact.

Music can also be used to connect the person living with dementia with their caregivers. In this way, music can improve quality of life, enhance intimacy and communication. What persons living with dementia need and what caregivers seek are activities that give meaning. Music, for most people, is valued. It is my firm belief that we can all use music in care. While there are scopes of practice that have expert training i.e. music therapy, every one of us can learn to integrate music into our regular practice of care. Using the pneumonic SMILE, here are 5 ways you can incorporate music into dementia care:

Sing. You don’t have to be an opera singer or rock star to sing during care procedures. Singing doesn’t mean performing, it means connecting. Think about singing as warm air, vibrations, human contact, PRESENCE. When to sing? During care procedures like bedside transfers, bathing, mealtime, taking medications. You may sing in order to cue these things, to mitigate fear and anxiety. Singing is simple, humming is simple still. It can be done wherever you are. You are focused only on the melody (tune) of music. You can use words or sing the tune only using syllables like LA LA LA. Choose a song that you are familiar with and one that can be used in a number of circumstances in a number of ways. Try LEAN ON ME.

Make musical visits . Musical visits can make good sense, especially for people who enjoy music. A musical visit doesn’t have to be long, 8-10 minutes would be appropriate. Use this format – each time because repetition is good.

Greet – Hello Jenny J (insert person’s name), how are you today? (use the tune Frere Jacques, or make up your own)
Move – depending on condition of person with dementia, take their hand, arm and move it or dance while singing la la la to a more upbeat song i.e. You Are my sunshine
Sing – One Song method – show you that in a moment Choose one song for yourself – it’s your song. You will master it. You will be known for it. Your patients, residents, loved ones, will connect you with that song. When they hear it, they know you’re coming. OR Choose one song for those being cared for. You use it with every patient or resident your care for. It won’t get old because you will change the volume, speed, intensity according to the situation.
OR
Choose one song per task . i.e. bathing – rubber ducky, transfer – humming lean on me, mealtime – I like to eat apples and bananas, bedtime – lullaby, daytime – you are my sunshine
Music-making - with an instrument – I would suggest an egg shaker. It’s small, inexpensive, can go in your pocket, can be easily grasped, it’s sound is gentle gentle and vibrations can be felt Close – same tune and format as Greet
except with something like “It’s time to say good-bye”

Individualize. Evidence suggests that familiar, preferential music is the most therapeutically effective in most situations. A group of nurses began to research the impact of individualized music on their patients. Gerdner and her group researched how personalized music would impact patients. They were interested in how music could modify behaviors. She has developed a guideline for using individualized music. ( Evidence-based guideline. Individualized music for elders with dementia . Gerdner LA, Schoenfelder DP.J Gerontol Nurs. 2010 Jun;36(6):7-15.)

Dan Cohen, a social worker has developed the music and memory project , also known as the ipod project, has developed a protocol for personalized music being delivered through ipods and headphones. Playlists are developed using specific music that is preferential to the person with dementia, specific tunes and specific performers. Often, family members help provide the information for the playlist development. With digital technology so readily available, music can be delivered via an mp3 player or ipod, an ipad. Using headphones make the delivery personal and mobile.

Look for resources. The ipod project has become a popular way of music care delivery to persons with dementia and can be used in home settings and healthcare facilities. Alzheimer Society Toronto has begun an aggressive project hoping that 10,000 ipods will be distributed and used by PWD over the next 3 years. The Room 217 Music Collection can now be delivered in its entirety on ipod shuffle. Meaningful musical activities include sessions with a music therapist, targeting specific outcomes using music. Snoezelen rooms, or sensory stimulation rooms, carts, devices may use music to help persons with dementia reconnect with their surroundings or to reduce anxiety. Singing programs like sing-alongs are becoming more popular but are dependent on people who are confident in music to lead them effectively. A number of LTC residences use videos of entertainers singing familiar music. Some LTC homes have their own singalong programs facilitated live or with recordings. The Alzheimer’s Society in England has an effective program called Singing for the Brain, a weekly gathering of persons with dementia and their caregivers. It is meant to be a safe place for connection around music. Room 217 has 3 videos called Recollections that have been created especially for visual and aural stimulation for persons living with dementia. They are meant to catalyze stories and conversations. Room 217 is developing a series of sing-along episodes on video that will have accompanying activities and training. We are currently in production and hoping to launch Pathways in the fall of 2015.

Evaluate. My favorite educational resource for caregivers looking to integrate music into their regular caregiving routines is a user-friendly book called Connecting through music with people with dementia by music therapist Robin Rio. It is a practical guide for caregivers with helpful tips, checklists and excellent background material. I’ve adapted one of Robin’s checklists, for the E of SMILE. When you are using music in care, you need to access and evaluate its impact. Music may not be for everyone. It might have adverse effects. By evaluating the effects of music on the person with dementia, you will be able to gauge how best to deliver music care for optimal impact. Here are some indicators for you to be aware of: